Provider Demographics
NPI:1215479076
Name:TAYLOR, URSULA E (MD)
Entity type:Individual
Prefix:DR
First Name:URSULA
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:E
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 E THOUSAND OAKS BLVD
Mailing Address - Street 2:STE 176
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:310-386-1177
Mailing Address - Fax:
Practice Address - Street 1:100 E THOUSAND OAKS BLVD
Practice Address - Street 2:STE 176
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:310-386-1177
Practice Address - Fax:805-870-4265
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine